Form L-4175 - Personal Property Statement - 2013
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Michigan Department of Treasury
Parcel No.
2013
632 (Rev. 10-12)
L-4175
2013 Personal Property Statement
(As of 12-31-12)
Location(s) of Personal Property Reported on This Statement.
FROM:
(Name and Address of Assessor)
LIST ALL LOCATIONS. Attach additional sheets if necessary.
Date of Organization
Date Business Began at above
location
TO:
(Name and Address of Taxpayer)
Assumed Names Used by Legal Entity, if any
Names of Owner(s) or Partners
(If sole proprietorship or partnership)
If Sole Proprietorship, Taxpayer's Residential Address
Please file by February 1, 2013.* Read instructions carefully. Additional notices are
found in the instructions. Form approved by STC on 10-30-12. Issued under authority of
P.A. 206 of 1893.
Legal Name of Taxpayer
Square Feet Occupied
Michigan Sales Tax No.
Check One Only:
Address Where Personal Property Records are Kept
Sole Proprietorship
Preparer's Name, Address and Telephone Number and E-mail address
Partnership
Name of Person in Charge of Records
Taxpayer Telephone No.
Limited Liability Co.
MI ID# ______________
Description of Taxpayer's Business Activity and NAICS Code
Corporation
Taxpayer Telephone No.
MI ID# ______________
SUMMARY AND CERTIFICATION.
Complete ALL questions.
If Yes, state total original cost
1.
Have you excluded any exempt "Special Tools" from this statement?
Yes
No
excluded _________________
2.
Have you excluded any air and water pollution control facilities and/or wind or water
Yes
No
energy conversion devices for which an exemption certificate has been issued?
If Yes, attach itemized list.
3.
Have you, to the best of your knowledge, reported all of your assessable tangible
personal property located in Michigan to the appropriate assessment jurisdiction?
Yes
No
If No, attach explanation.
4.
Did you hold a legal or equitable interest in personal property assessable in this
jurisdiction which you have not reported on this statement (see instructions)?
Yes
No
If Yes, attach itemized list.
5.
Are you a party (as either a landlord or a tenant) to a rental or lease agreement relating
Yes
No
to real property in this jurisdiction?
If Yes, complete Section O.
6.
Have any of your assets been subjected to "rebooking" of costs for accounting
purposes or been purchased used (see instructions)?
Yes
No
If Yes, attach itemized list.
7.
Is any of your property "daily rental property," per P.A. 537 of 1998?
Yes
No
If Yes, attach Form 3595.
8.
Have you reported all fully depreciated or expensed assets that are assessable?
Yes
No
Yes
No
9.
Are other businesses operated at your location(s)?
If Yes, attach itemized list.
Assessor Calculations
Enter zero if appropriate.
10a.
Grand total from page 2
10b.
10.
11a.
Grand total from page 3
11b.
11.
12a.
Grand total from page 4
12b.
12.
13a.
Total cost of Idle Equipment from Form 2698
13b.
13.
X .50
14a.
14.
Total cost of Personal Property Construction in Progress
14b.
Total cost of Cable TV, Utility and Wind Energy Assets from Forms 633, 3589 and 4565
15a.
15.
15b.
16a.
16.
Total cost of cellular site equipment from Form(s) 4452
16b.
TOTAL
The undersigned certifies that he/she is an owner, officer and/or the duly authorized
ASSESSOR'S ADJUSTMENT(S)
agent for the above named taxpayer and that the above summary, with its supporting
EXEMPTION(S)
documents, provides a full and true statement of all tangible personal property
owned or held by the taxpayer at the locations listed above on December 31, 2012.
TRUE CASH VALUE
Signature of Certifier
Date
ASSESSED VALUE (50% of TCV)
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